1. What is your sex?
2. What age group are you?
3. What is your ethnic group?
4. Are your day to day activities limited because of a health problem or disability which has lasted, or is expected to last at least 12 months? (include any issues/problems related to old age)
5. We would like you to think about your recent experiences of our service. How likely are you to recommend our GP Practice to friends and family if they needed similar care of treatment?
6. What was good about your visit?
7. What would have made your visit better?
8. Would you consent to your comments being published?